Skin / Non Surgical

Injectables

Cosmetic surgical procedures can produce profound, long lasting changes in facial appearance, but are invasive and have an associated recovery period. Many patients who are just beginning to show signs of facial aging desire improvement, but cannot justify the cost or time investment required for surgical intervention. For these patients, the rapidly expanding repertoire of injectable treatments is perfect to suit their needs. Injectables can be utilized during an office visit, rather than requiring a trip to the operating room. With some treatments, no anesthetic is necessary, as the needles utilized are so small that discomfort is minimal. With others, topical anesthetic agents may be utilized, depending on the patient’s preference and the sensitivity of the region being treated.

From the standpoint of using minimally invasive techniques to treat facial wrinkles, there are two general classes of injectables:

BOTOX®

The first option, which is most appropriate for active lines or age associated wrinkles that are just starting to appear, is to temporarily weaken the muscle that is causing the wrinkle. Botulinum Toxin type A is a family of neurotoxins that block nerve signals that cause muscles to contract. The toxin works directly where it is placed, and thus can be artistically used to alter facial expressions. Botox Cosmetic® is widely recognized, and was the first neurotoxin to be approved for cosmetic use in the United States. The clinical effects of Botox Cosmetic® are typically 3 to 4 months. Risks include bruising at the injection site, rare chance of an infection, and the possibility of unintentionally affecting nearby muscle groups. Specific risks should be discussed with Dr. Feinberg when considering treatment.

Soft Tissue Fillers

The second option of injectable treatments are the soft tissue fillers These injectables are more useful for treatment of firmly established wrinkles or larger lines of facial aging (such as the nasolabial folds). Fillers restore volume to the face and can add structure as well. Depending on the type of filler and the depth at which it is injected, you can smooth out fine lines on the surface of the skin, fill out deep lines (eg: nasolabial folds), augment soft tissues (such as the lips), or even effectively augment facial bone structure. All of these injectable fillers are placed by an injection, so the group carries usual risks of bruising, lumpiness, redness, product specific adverse reactions, and in rare cases local infections.

The most commonly used class of fillers is based on hyaluronic acid (HA), which is a sugar found naturally in human tissues. A major benefit of this filler class is that allergic reactions are extremely rare, and no pre-treatment skin testing is necessary. These compounds bind water similar to the way a sponge absorbs water. Because of this, they plump the skin in the treated region. The various formulations expand the repertoire of options available to us, as certain products are better suited for different anatomical regions. Formulations with smaller particle sizes tend to be softer and smoother, and work well in regions such as the lips. Larger particles have more structure, and are best suited for deep folds such as the nasolabial creases. Hyaluronic acids are eventually absorbed by your body, and the length of time is dependent on a multitude of factors including the patient, the location of injection, and the particular product used. Results last from 3 months in high mobility areas (such as the lips), and up to 1 year in regions such as the nasolabial folds, with most patients experiencing the desired effects for at least 6 months.

Another class of fillers has been introduced that is based on microsphere technology. Microspheres are tiny round particles of solid material that are relatively uniform in size. Two formulations are FDA approved for use, differing in design and expected longevity of results. These products are used for volume replacement and for deep facial wrinkles (such as the nasolabial folds.) They are not approved for use in the lips.

Radiesse® contains mirospheres are made of calcium hydroxylapatite suspended in a gel carrier. The filler is broken down by the body in two phases, first the carrier and then the spheres. During this process, collagen ingrowth occurs, which is expected to provide a long lasting effect. This prolonged degradation process makes Radiesse® a longer lasting filler than those previously discussed, with expected results lasting a year or more.

Sculptra® is another product that has a unique mechanism of action. It actually stimulates your body to produce collagen in the treated areas. It is utilized where there are signs of thinning of the facial tissues in both the aging patient as well as the athletic younger patient with little body fat. The results of Sculptra® last up to two years.

Recommendations

Although there are many options available, there is no “one best product” for any particular use. You will discuss your areas of concern with Dr. Feinberg and he will recommend the best course for you to follow. If you are considering soft tissue fillers, it is a reasonable practice to first try short acting agents to be certain that you enjoy the effects of treatment before utilizing longer acting agents.